Big Drop in Breast Cancer Deaths Among Young Women (5 minutes reading) 

A new study shows that breast cancer deaths in women aged 20 to 49 dropped sharply between 2010 and 2020. The biggest improvements came after 2016, thanks to better treatments, more targeted medicine, and improved access to care.

Researchers looked at over 11,000 deaths and found that all types of breast cancer and all racial and ethnic groups saw declines. The most common type, called luminal A, had the biggest drop. However, younger women (ages 20–39) with this type had lower survival rates than expected, which may mean their cancers behave differently.

Despite the progress, Black women still had the highest death rates and the lowest survival, showing that health gaps remain. Experts say more research and better access to screening and treatment are needed, especially for high-risk and underserved groups.

This study highlights how far we've come in fighting breast cancer in young women—but also how much more we can do to save lives.

Source: LINK 

 

Prevention and Screening Save Lives in Five Major Cancer Types

From 1975 to 2020, efforts in prevention and screening helped avoid 4.75 million deaths from breast, cervical, colorectal, lung, and prostate cancers. This study by the National Cancer Institute (NCI) shows that these efforts have saved more lives than treatment advances.

Key findings include that smoking cessation prevented 3.45 million deaths from lung cancer. In breast cancer, treatment advances saved most lives, with mammography screening also contributing. Screening and removal of precancerous lesions prevented 160,000 deaths from cervical cancer. Screening and removal of polyps averted 79% of 940,000 deaths from colorectal cancer. PSA testing and treatment advances saved 360,000 lives from prostate cancer.

The study emphasizes the importance of combining prevention, screening, and treatment to reduce cancer death rates. The Biden Cancer Moonshot aims to cut the cancer death rate by 50% by 2047, highlighting the crucial role of prevention and screening efforts.

source: LINK

A SIMPLE TECHNIQUE MAY BE MOST EFFECTIVE IN PREVENTING HEART DISEASE AFTER RADIATION THERAPY FOR BREAST CANCER

 Women who have breast cancer on their left side present a particular challenge to radiation oncologists. Studies have shown that the risk of heart disease is higher in this group of women after radiation treatment because it can be difficult to ensure that a sufficient dose of radiation is delivered to the left breast while adequately shielding the heart from exposure. New research shows a woman who holds her breath during radiation pulses can greatly reduce radiation exposure to the heart.

"Radiation therapy is commonly prescribed to patients with breast cancer following surgery as a component of first-line therapy," said first author Harriet Eldredge-Hindy, M.D., a Chief Resident and researcher in the Department of Radiation Oncology at Thomas Jefferson University "We wanted to determine how effective breath-hold could be in shielding the heart from extraneous radiation exposure during treatment of the left breast."

Recent studies have shown women with cancer in the left breast are at higher risk of heart disease, and that the risk increases proportionately with the dose of radiation the heart is exposed to during treatment. A number of techniques have been developed to reduce exposure to the heart including prone positioning (lying flat on the belly on a bed that only exposes the left breast), intensity-modulated radiation therapy (IMRT), and accelerated partial breast irradiation. The breath-hold technique allows doctors to monitor a patient's breath for the position that shifts the heart out of the range of the radiation beam.

In the largest prospective study to date, following women for 8 years post treatment, 81 women were asked to hold their breath during radiation treatment for breast cancer- a process that was repeated until therapeutic dose was reached. The researchers found that patients capable of holding their breath over the course of treatment had a 90 percent disease-free survival, and a 96 percent overall survival, with a median reduction in radiation dose to the heart of 62 percent. The findings were published online this week in the journal Practical Radiation Oncology.

"Given that this technique helps to shield the heart during radiation treatment for breast cancer," said Rani Anne, M.D., Associate Professor of Radiation Oncology at Thomas Jefferson University and senior author on the study, "we routinely offer breast cancer treatment with the breath hold technique at Jefferson."

Source: EurekAlert

THE COST OF NEW DRUGS FOR BREAST CANCER PATIENTS

The newest recommendation of the American Society of Clinical Oncology (ASCO) 2014 for HER2+ metastatic breast cancer patients recommends the use of new drugs like pertuzumab and T-DM1 for first and second line, respectively.  The Perjecta costs is 6.000 USD a month and for trastuzumab is 4500 USD a month. Thus, the costs for first line (without including the costs for taxotere) will be over 10000 USD a month!. For the T-DM1 (recommended second line), the drug will cost 9800 USD a month! … it is clear that but the costs of such new medicines for uninsured patients or 99% of patients from countries in development will be impossible to afford! I strongly disagree with this!

© Luis Mendoza

NEW TASK FORCE RECOMMENDATIONS FOR BRCA MUTATION SCREENING

Updated recommendations issued by the United States Preventive Services Task Force (USPSTF) state that primary care physicians should screen women who have a family history of either breast, ovarian, tubal, or peritoneal cancers as they may be carriers of a mutation in one of the breast cancer susceptibility genes—BRCA1 or BRCA2. Screening should be done with one of several screening tools available and included in the current update. 

The task force recommends against testing for women who have an average risk of being diagnosed with breast cancer. 

“The goal of the recommendation is to encourage clinicians to assess a woman’s family history of BRCA-related cancers, so as to identify those women who may benefit from further evaluation,” Douglas K. Owens, MD, professor and director of the Center for Health Policy at the Stanford University School of Medicine and one of the USPSTF members, told Cancer Network in an email. 

The current update from the task force, which is chaired by Virginia A. Moyer, MD, MPH, reaffirms the last update of these recommendations made in 2005. 

“The main change is that there is now evidence to support the use of screening tools that clinicians can use to screen women and identify those who are candidates for genetic counseling and further evaluation,” said Owens. “The grades of the recommendation have not changed.” 

The updated recommendations are published in the Annals of Internal Medicine. 

Those women who have one or more family member with a potentially harmful BRCA mutation should be offered genetic counseling and testing. 

The tools listed in the recommendation include the Ontario Family History Assessment Tool, Manchester Scoring System, Referral Screening Tool, Pedigree Assessment Tool, and the FHS-7 tool. All are questionnaires that add up risk factors for these cancers such as the number of family members with a history of breast or ovarian cancer and the age of onset. The tools are a way to help clinicians discuss whether there are factors present that make it more likely their patient is a BRCA mutation carrier. The task force estimates that the tools are more than 85% sensitive. No one test was recommended for use over another. 

The two most simple and quickest to use, according to the task force, are the Referral Screening Tool and FHS-7. 

Use of these structured screening tools to assess the need for more in-depth genetic counseling may be relatively new for some clinicians, Owens noted. 

BRCA mutation testing should only be done for those patients who have either a personal or family history that suggests a role of inherited cancer susceptibility. Testing for these mutations are now more widely available following a June 2013 decision by the Supreme Court. 

In the United States, approximately 12.3% of women will develop breast cancer during their lifetime and 2.7% will die of their disease according to the National Cancer Institute. About 1.4% will develop ovarian cancer and 1% will die of their disease. 

Analyses of the penetrance of BRCA1 and BRCA2 genes suggest that a woman’s risk of a breast cancer diagnosis jumps from 45% to 65% by the age of 70 if she is a carrier of a deleterious BRCA mutation. A mutation in the BRCA1 gene increases ovarian cancer risk to about 39% by age 70 and to 10% to 17% for those who are BRCA2 mutation carriers. 

Between 1 in 300 and 1 in 500 women carry a BRCA mutation (between 0.2% and 0.3% of the population) with a higher prevalence (about 2.1%) for the general Ashkenazi Jewish women population. 

Understanding the chance of being diagnosed with breast cancer is important. A recent survey and analysis of more than 2,500 adults published in Genetics in Medicine shows that despite the recent coverage of breast cancer risk and Angelina Jolie’s decision to undergo a double mastectomy, women still do not have a better understanding of breast cancer risk including how rare Angelina Jolie’s decision was and what to do if one is positive for a deleterious mutation that confers an increased cancer risk. 

The study also showed that many did not understand the relationship of overall cancer risk and risk in the context of a family history of cancer. “Perhaps even more striking and worrisome is that about half of all individuals aware of the story and without a family history of cancer rated their cancer risk as lower than the population average relative to those without a family history and unaware of the story,” said the authors. 

This type of analysis points to a greater need for primary care physicians to discuss cancer risk with patients to guide their education and awareness about the issue, particularly as the genetics of cancer is increasingly an important factor in diagnosis and treatment. 

The endorsement of family history screening tools to identify candidates for testing could be problematic because the correct threshold for testing is still not resolved, noted Mark Robson, MD, an oncologist who specializes in identifying and managing women with inherited breast cancer risk and the director of the clinical genetics service at the Memorial Sloan-Kettering Cancer Center in New York. 

“The limitation here is that USPSTF has not provided guidance about testing for affected women, who should be the first ones tested in a family,” said Robson in an email. “The USPSTF has not really provided much in the way of endorsement for the screening and prevention interventions that would follow from testing.” 

Source: cancernetwork.com

ALERT! BREAST CANCER 'RISING IN UNDER-40S' ACROSS EUROPE

A latest information A study in Cancer Epidemilogy found cases rose by about 1% a year between 1990 and 2008 in seven EU countries. Rises in breast cancer rates could be caused by a range of things that can increase the risk of breast cancer, such as women having fewer children and having them later in life, or greater awareness and diagnosis in this group.

My strong recommendation to women after 40 years old is to reduce the risk of breast cancer by keeping active and cutting down on alcohol. Also get to know your breasts and, if you notice any change, tell your doctor without delay.

More info HERE  http://www.bbc.co.uk/news/health-24746437

ANGELINA JOLIE´S DOUBLE MASTECTOMY

Actress and activist Angelina Jolie's recent decision to have a preventive double mastectomy highlights the difficult choices facing women who find out they have a high risk for breast cancer because of their genes.

Although relatively rare, mutations in the BRCA1 and BRCA2 genes raise the risk of breast cancer by as much as 80%, experts say. The mutations also raise the risk of ovarian cancer.

Jolie describes in a New York Times op-ed piece why she decided to go through with the surgery. At 37, the mother of six wants to stay healthy and active for her family -- and to reassure them that she is doing everything possible to avoid the disease that took her mother's life: cancer.

“I wanted to write this to tell other women that the decision to have a mastectomy was not easy,” Jolie writes. “But it is one that I am very happy I made. My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don’t need to fear they will lose me to breast cancer.”

Why do women undergo a preventive double mastectomy?

In Angelina Jolie's case, she had a mutation that puts her at very high risk for getting breast cancer at some point in her life. Right now the most effective prevention that we have for [this] BRCA mutation carrier is a prophylactic double mastectomy.

It is always a double mastectomy because both breasts are at risk and you don’t know which breast is going to get breast cancer when women have a BRCA mutation.

How many women have the BRCA mutation?

Only about 5% of all breast cancers are in women who have this genetic mutation.

Is the breast cancer linked with this mutation more aggressive than others?

Yes, BRCA mutations are associated with a more aggressive breast cancer that is known as "triple negative."

Do some experts think that performing a double mastectomy is too radical for those who test positive for BRCA mutations?

I think most breast cancer experts would agree that the choice is really the patient's to make, and I really want to emphasize, it is a choice.

Preventive mastectomy is one very excellent choice. But another choice women can consider when they know they carry a BRCA mutation is early detection. And that comes with more active screening. If a woman knows she has a BRCA mutation and does not want to have a mastectomy, a good alternative is to have a mammogram and a breast MRI every year. You can do both at once or choose to alternate. [For my patients] I choose to alternate, doing one test every 6 months.

It's not as effective because by definition you are picking up cancer as it develops. But it is effective at picking up cancer at a very early stage.

If a woman has a preventive double mastectomy, what are the benefits and risks?

In women at higher risk -- those with BRCA mutations -- preventive surgery can reduce the risk of breast cancer by 90%. If the [increased] risk is 80% as it is for many BRCA carriers, this can reduce the risk of breast cancer by 90%.

In other words, this can reduce the risk to that lower than the general population. The risks [of the mastectomy] are not that great. Most women having preventive mastectomies are younger patients, and many choose to get reconstruction. A lot of the risk has to do with the implants, like implant complications, or other risks [linked with surgery] such as infections or bleeding.

Who should consider BRCA testing?

The women who should absolutely consider it are those who themselves have had a triple-negative breast cancer, the kind associated with BRCA mutations, at an early age, under 45, people who have had both ovarian and breast cancer in family members, and people who have breast cancer in the family and are of Ashkenazi Jewish descent.

What is involved in testing for BRCA mutations?

It is a simple blood test, or they can swab the inside of your cheek. The best way to get this test is to go for counseling from a genetic counselor. Have them talk to you about the possibility of testing positive. Women really need to be counseled about what this means, what the results mean, what their risk is, and then to make the decision about whether to get the test.

If you only get tested for the three most common mutations, results take about 2 weeks. The more comprehensive test, where they do gene sequencing, can take a month.

What is the cost and who pays?

The cost is about $3,000. The cost of testing is covered by many insurance companies [if you are deemed high risk].

By Kathleeen Doheny

WebMD Health News

Reviewed by Michael W. Smith, MD

STUDY: BIENNIAL MAMMOGRAMS MAY BE BETTER FOR SOME WOMEN

Research suggesting that annual mammograms may not be best for most women received a fair amount of coverage online, and was featured on two of last night's national news broadcasts. Most sources point to the fact that advice on mammogram frequency varies among medical groups, and that these findings back up recommendations from the US Preventive Services Task Force. Meanwhile, some sources mention that certain groups were critical of the study.

        The CBS Evening News (3/18, story 8, 2:30, Schieffer, 5.58M) reported that a new study has "found that doing mammography every two years rather than every year did not increase the risk of advanced breast cancer."

        ABC World News (3/18, story 5, 2:05, Sawyer, 7.43M) reported that the study "revealed 60% of abnormal mammograms turn out to be false positives, not cancer at all, even though they can lead to biopsies, even surgery." During a second segment on the topic on ABC World News (3/18, story 6, 0:50, Sawyer, 7.43M), ABC's Dr. Richard Besser said, "I think this is one of the most important things you can do, with whatever serious illness you have. It's to ask this question. Say to your doctor, 'Before we go forward with any treatment, let's get a second opinion. And is there someone you can refer me to?' The best doctors are going to welcome another set of eyes, another way of looking at it."

        CBS News (3/19) reports on its website, "The results, which were published on March 18 in JAMA Internal Medicine, follow the 2009 recommendation by the US Preventive Services Task Force that advocated for biennial mammography for women in this age group instead of the previous suggestion of getting screened every one to two years." In the new study, "the researchers looked at data from 11,474 women with breast cancer and 922,624 women without breast cancer who underwent screenings at US facilities involved in the long-running Breast Cancer Surveillance Consortium (BCSC) from January 1994 to December 2008." The researchers fond that "women who went every two years for a screening were not associated with an increased risk of advance stage breast cancers or large tumors, even if the woman had dense breasts or used hormone replacement therapies, when compared with women who were screened every year."

        Bloomberg News (3/19, Cortez) reports, "The study found an exception for women 40 to 49 years old with extremely dense breasts." These individuals "were about twice as likely to be diagnosed with large tumors or advanced cancer if they skipped mammograms." Additionally, "they...had higher rates of false-positive results."

        Reuters (3/19, Steenhuysen) reports, however, that some groups, including the American College of Radiology, criticized the study, arguing that its methodology was flawed.

        False-Positive Mammograms May Have Negative Psychological Effects. The Los Angeles Times (3/19, Brown, Times, 692K) reports, "Long after learning that a troubling reading on a screening mammogram was just a false alarm, women continued suffering negative psychological effects, researchers in Denmark have reported" in the Annals of Family Medicine. Researchers found that, "six months after hearing they did not have breast cancer, women with these false positives experienced changes in 'existential values' and 'inner calmness' as great as for women who had cancer."

        On its website, ABC News (3/19, Moisse) reports that additionally, "women who had false positives were...more likely to report disturbances in sleep and sexuality, according to the study."

        The NBC News (3/19, Fox) "Vitals" blog reports that the researchers wrote, "False-positive findings on screening mammography causes long-term psychosocial harm: Three years after a false-positive finding, women experience psycho-social consequences that range between those experienced by women with a normal mammogram and those with a diagnosis of breast cancer."

RACE AND BREAST CANCER

The relationship between race, ethnicity, and breast cancer is complex. Many studies have shown that women of different racial and ethnic backgrounds have different rates of developing and surviving breast cancer, but the reasons for this difference aren't always clear.

According to the National Cancer Institute, white women are the ethnic group most likely to develop breast cancer, while Korean American women are the least likely. However, black women have a greater chance of being diagnosed with more aggressive, advanced-stage breast cancer. They are also more likely to be diagnosed at a younger age and tend to have a worse prognosis (chance of recovering).

Risk factors and race

Researchers have found that some of the differences in cancer diagnosis and survival may be linked to the fact that many black women have less access to regular medical care, such as having a primary care doctor. Having a primary care doctor increases the chance that a person will have regular check-ups and screening tests that may find breast cancer at an earlier stage before it has the chance to spread.

Various lifestyle factors that are more common in some ethnic groups, such as unhealthy eating habits and weight issues, as well as other health concerns, such as diabetes and high blood pressure, may also influence prognosis. Research has shown that obesity is a major risk factor for developing breast cancer, as well as decreasing recovery and survival following treatment, no matter what race you are.

Genetic factors

There are also genetic (inherited) factors associated with a person’s racial and ethnic ancestry that influence breast cancer development and survival. For example, Ashkenazi (Eastern European) Jewish women have a higher risk of carrying specific mutations (changes) in theBRCA breast cancer susceptibility genes that make them more likely to develop breast and/or ovarian cancer than women who do not have a BRCA mutation.

African ancestry has been linked with an increased risk of developing a particular type of breast cancer known as triple-negative breast cancer. This type of cancer is called ”triple-negative” because the tumors do not have receptors for estrogen and/or progesterone, like normal breast tissue does, and they do not have a protein called human epidermal growth factor receptor two (HER2). As a result, triple-negative breast cancers do not respond to medications that block estrogen production or receptors, like tamoxifen (Nolvadex, Soltamox) or aromatase inhibitors, or to HER2-blockers like trastuzumab (Herceptin) and lapatinib (Tykerb).  As a result, chemotherapy is often the treatment of choice, but when it does not work, triple-negative cancers may be difficult to treat. 

Interestingly, male breast cancer is also more common among African as well as African American men. Learn more about the genetics of breast cancer.

Steps you can take

Although you can't change your race or ethnicity, there are still a number of things you can do to lower your risk of breast cancer. First, it is important to talk with your doctor about getting a mammogram and decide on an appropriate screening schedule.  The U.S. Preventive Services Task Force recommends that women between the ages of 50 and 74 have a mammogram every two years and that mammography be considered in women aged 40 to 49 after evaluating the risks and benefits of this test with a doctor. The American Cancer Society recommends yearly mammography beginning at age 40. If you are worried about the cost of these tests, there are programs, such as the Centers for Disease Control and Prevention’s  National Breast and Cervical Cancer Early Detection Program, that provide free or low-cost mammograms to women who qualify. Find other financial resources that can help you manage the cost of cancer care.

If you have been diagnosed with breast cancer, it is important to talk with your doctor about the most effective treatment plan for your type and stage of cancer. Researchers have found that black women are less likely to get high-quality treatment if they have cancer, often due to a lack of social and economic resources. It is also important to consider participating in a clinical trial. Black women and women of other ethnic groups do not participate in clinical trials as frequently as white women and, therefore, have less access to new and promising therapies. A lack of participation in clinical trials also means that less is learned about cancer in women who are members of minority groups.

In addition, you can make healthy lifestyle choices that can keep your risk of developing cancer as low as possible and improve your health after a cancer diagnosis. This includes:

• Maintaining a healthy weight
• Exercising regularly
• Limiting the amount of alcohol you drink
• Eating nutritious food
• Stopping tobacco use

Learn more about risk factors and prevention.

Understanding risk and statistics

Cancer risk and survival statistics should be interpreted with caution. Although these numbers may be a good way to learn about how race may influence breast cancer risk and survival, they can't predict if someone will develop breast cancer or how well a treatment will work for a specific person. Your doctor can help you understand how these statistics relate to your chances of developing breast cancer or chances of being successfully treated. Learn more about cancer statistics.

Source: cancernet.com